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Optimal Timing of Delayed Free Lower Abdominal Flap Breast Reconstruction after Post-mastectomy Radiation Therapy
Donald P. Baumann, MD, Melissa A. Crosby, MD, Jesse C. Selber, MD, MPH, Patrick B. Garvey, MD, Justin M. Sacks, MD, Mark T. Villa, MD, David M. Adelman, MD, PhD, Geoffrey L. Robb, MD, PhD.
MD Anderson Cancer Center, Houston, TX, USA.
Purpose: In women diagnosed with locally advanced breast cancer, breast reconstruction with a lower abdominal flap is typically deferred until all oncologic care, including adjuvant chemotherapy and post-mastectomy radiation therapy (PMRT), has been delivered. There is no study to date that defines the ideal timing of delayed breast reconstruction (DBR) in patients with locally advanced breast cancer. The purpose of this study was to determine the optimal timing of delayed lower abdominal flap breast reconstruction following PMRT by evaluating the association between interval duration and postoperative complications.
Methods: We reviewed a prospectively maintained database of DBR performed between July 2005 and December 2009. Demographics, data, operative variables and clinical outcomes were collected. Patients were classified as having undergone reconstruction within 12 months after the completion of PMRT (group I) or 12 months or more after the completion of PMRT (group II). Recipient site complications were compared between groups including microvascular thrombosis, partial flap loss, total flap loss, fat necrosis, infection, wound dehiscence and seroma.
Results: One hundred eighty-nine patients were identified, 82 patients (43.4%) in group 1 and 107 patients (56.6%) in group II. The median age of the patients was 48 years (range, 22 to 72 years), and the median BMI was 28 kg/m2 (range, 13 to 43 kg/m2). The median follow-up period in group I was 302 days and in group II 211 days, (p=0.087). Ninety-four patients (49.7%) underwent reconstruction with msTRAM flaps, 80 patients (42.3%) had DIEP flaps, and 15 patients (7.9%) had SIEA flaps. There was no difference in flap distribution or recipient vessels (internal mammary, thoracodorsal) between groups, (p= 0.914 and p=0.563, respectively). The total flap loss rate was 2.6% with all flap losses occurring in Group I (p = 0.014). A total of 49 patients (26%) experienced at least one postoperative recipient site complication; group I patients trended towards a higher incidence of microvascular thrombosis, infection and wound dehiscence. As a result the re-operation rate was higher in Group I (14.6% vs. 4.7%, p = 0.022).
Conclusions: Patients who underwent delayed breast reconstruction after 12 months from the completion of PMRT developed fewer complications, including microvascular thrombosis and total flap loss, than those who underwent delayed breast reconstruction within 12 months of completing PMRT. Allowing an interval of 12 months between the completion of PMRT and delayed abdominal free flap breast reconstruction will likely minimize complications and optimize outcomes in free flap breast reconstruction in patients receiving post-mastectomy radiation.
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